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The aim of the study was to determine the prevalence of caries in patients who are heroin addicts and the effects of salivary flow and saliva pH on its prevalence. The study included 200 subjects (100 subjects diagnosed with heroin addiction as the test group and 100 subjects taking no addictive substances as the control group). In both groups, saliva status was established by determining flow rates and pH of stimulated and unstimulated saliva. The total number of dental caries cases was determined using the DMFT index and their more specific detection in the context of localization on the tooth using the DMFS index. The DMFT index was higher in the test group (mean 18.78) than in the control group (mean 5.32), with a statistically significant difference (P < 0.000). The highest caries prevalence in both groups was recorded on occlusal dental surfaces (44.70% in the test group and 16.20% in the control group). The prevalence of caries of vestibular dental surfaces was higher in the test group (9.40%) than in the control group (2.34%), and the difference was statistically significant (P < 0.000). A statistically significant correlation was established between heroin addiction and reduced production of unstimulated saliva (P < 0.001) and stimulated saliva (P < 0.002), as well as pH values of stimulated saliva (P < 0.001) and unstimulated saliva (P < 0.001). In conclusion, a higher prevalence of caries of hard dental tissue was found in the test group. The flow of stimulated and unstimulated saliva as was as saliva pH was lower in the test group.